As with any surgical procedure, there is a risk of infection with permanent pacemaker insertion. Surgical risks are higher if the patient has high-risk characteristics such as:

Serious complications are rare, occurring in 1 to 2 percent of cases. They may include:

• Severe bruising or bleeding
• Formation of blood clots
• Tearing of a blood vessel
• Puncturing of the lung or heart muscle
• Injury to the tricuspid valve
• Stroke
• Heart attack
• Introduction of air into the space between the lung and chest wall (which could lead to an embolism)
• An electrode dislodging from the heart
• Infection
• Pacemaker malfunction

Furthermore, some people face the risk of developing pacemaker syndrome, in which the implanted pacemaker is no longer synchronized with the heart’s own rhythm and attempts to pump blood through a closed valve. This restricts the flow of blood from the heart, causing dizziness and fatigue. Such a problem can be managed by using a different type of pacemaker.

Patients should immediately report the following symptoms to their physician:

• Redness, warmth, tenderness or swelling of the incision site, alone or with a fever
• Drainage of liquid from the incision site, alone or with a fever
• Swelling (edema) of arms, legs, wrists or ankles
• Increased shortness of breath, prolonged hiccupping or difficulty breathing
• Prolonged weakness or fatigue
• Fainting, lightheadedness or dizziness
• Fast or pounding heartbeat (palpitation)
• Muscle twitches
• Chest pain
• Any return of symptoms experienced before the implantation

A recent study suggests that up to 20 percent of patients with pacemakers or other implanted devices may be at higher risk of developing bacterial blood infections. Sometimes the device itself is the cause of the infection. Depending on the situation, physicians may elect to either treat the infection with antibiotics, or remove the pacemaker.